[CaminoDeOro]

I know meds are different for everybody. I know, I know, I know.

I'm just curious if anyone else experienced major irritability or agitation which took a while to get going after switching to seroquel.

As it says in my signature I am currently working with my pdoc to systematically try meds one at a time. I went on seroquel at 100 for a month, then up to 150, then after looking at the mood charts, went back down to 100 a little over a week ago.

Seroquel seems to be a big help to my baseline mood and my ability to bounce back from setbacks. My default mode is depression, I have ultrarapid cycling but if you zoom out I've been in a bad low for almost 5 years. My life is chaotic, so the fact that I can bounce back a lot faster when the BS hits is helpful. But I noticed almost immediately that Seroquel does NOTHING for my stability, in fact might even make it worse. Now I'm starting to think that it's causing irritability and agitation which is starting to get pretty ridiculous. I'm not positive of that though, it's less clear-cut than the other stuff I'm keeping an eye on while tracking my moods, and I was having a bit of trouble with it before going on the Seroquel.

I am suspicious for a couple reasons. First, I know that this is a possible side effect of antipsychotics, and I do occasionally get restless leg after a seroquel dose, much more so the first week, now it's fairly rare except late in the evening. I haven't heard that seroquel is known for it, but Abilify for example I've found has a bad reputation for irritability, agitation, and anger. I tried Abilify a number of years ago and had to stop within 2 days due to extreme agitation, panic, etc to the point where I juuust barely avoided throwing up in public, etc. So one medication in the class has done it to me already, albeit much faster and more clear-cut.

This is terrible, because the mood effects from seroquel are a huge improvement from my perspective. But if I am unstable and frequently deadlocking due to rage and so forth, I don't get too much more stuff accomplished to rebuild my life than I do if I'm just depressed. Fortunately I have good self-control (at least when people are around) and mostly just yell to myself when I'm alone, and I've attacked furniture a couple times. :P

I feel like the next step is to drop the lamictal and try a different stabilizer. The meds are such a frigging mess of contradictions - a benefit and a cost that is hard to weigh. Dexedrine is similar, a large benefit, and a large cost. I am so sick of this, but there is no other choice than to be systematic and grind through gathering data until we figure out the best combo, even as life continues to throw endless crap at me.

[CloserToTheMid]

I had that problem precisely. It happened every day at 5pm or so. I became a bear. My wife eventually asked me to get off it so I went to my pdoc and went on saphris. Works great, but too sedating. Couldn't think straight. On Vraylar now. It has side effects, but I'm dealing with it so far.

[Sunflower123]

I didn’t experience irritability....just overwhelming sedation.

[CloserToTheMid]

Originally Posted by Jennifer 1967

I didn’t experience irritability....just overwhelming sedation.

Yes, I felt high/drunk.

Well, I had to be upped to 600 mg Seroquel XR to curb a recent moderate mania. Now I'm just great. We are all different. If I only took 100 mg Seroquel XR with my Tegretol XR and Lamictal I'd surely be in very bad shape.

My psychiatrist says that Seroquel or Seroquel XR have a pretty low incidence of EPS. That has shown to be the case for me. I am almost off of Geodon, which gave me akathisia, and the akathisia is gone despite being on Seroquel XR. The meds that gave me akathisia were Zyprexa (right away), Abilify (right away), and eventually Geodon after five and a half years. I've been on at least 300 mg of Seroquel XR for five years now.

[CaminoDeOro]

Yeah, being a CYP2D6 poor metaboliser, a lot of meds (seroquel included) build up in my body much more than most people. This is true for about 10% of people depending on race. It's why 100mg is plenty for me. 2.5mg zyprexa is a solid dose for me, to the point where I got major side effects and a strong therapeutic effect from a dose so low insurance has tried to cut me off more than once, saying it couldn't possibly be doing anything.

CYP2D6 makes a huge difference in med response.

Anyway, my default baseline when not cycling is moderate to severe depression. Here are the atypicals I've tried.

zyprexa: great for stability. aside from the first time on it, does nothing for depression
abilify: immediate agitation, very bad reaction.
geodon: on it for a month, felt surly and mean.
seroquel: among the best substances I've tried for depression, but I am very unstable.

SIGH.

[AspiringAuthor]

I had this problem to the extreme and stopped Seroquel.

Now I am back on it, with Atarax (or to a lesser extenet Gabapentin) to ameliorate knee jerks. As a result, I sleep well. Seroquel is the best sleep med for me. For mood, also is very good, though I am somewhat hypomanic and the pdoc and I are watching. I am enjoying it, but one has to be careful, as we all know.

Atarax 100 mg works for me with 600 mg Seroquel. I would imagine that 50 mg Atarax would be enough for you on 100 mg Seroquel. Maybe even start with 2 mg. Atarax is a sedative antihistamine.

[AspiringAuthor]

PS On 100 mg of Seroquel I went manic without realizing it. Since I was sleeping, i thought I was fine and I did not even pay attention to the fact that I stopped needing food and subsisted on chocolate milk alone. Ended up in trouble, went in patient, Seroquel was raised to 600 mg. On 100 mg I experienced racing thoughts without realizing it. You are BPII, but still...

[still_crazy]

hi. i dropped old school seroquel because i was angry and oversedated, plus id have vivid nightmares and wake up sweaty, with sore muscles.

for me, abilify has been a good thing. we really are -all- different. if low dose zyprexa was helpful, maybe try Symbyax? its prozac and zyprexa together, and I think there's one w/ 3mgs zyprexa and 25mgs Prozac...something like that...

...anyway, there's actually some solid data on the combination for bipolar I and "treatment-resistant depression," so...maybe give it a shot?

[WildcatVet]

I too experienced irritability, restlessness, agitation...no sedation at all. Like my mild bad hypos. Didn't take it for long...now on Abilify which is pretty good...but going back on Vraylar ASAP.

[Guiness187055]

No irritability here. Just tons of sedation and one heck of an appetite.

[La.Last.Lucy]

Yes, meds are different for everybody... which can be frustrating when bringing up a certain med for a certain symptom & like wanting clear-cut answers. I have never been able to entirely figure out before how I will react to an RX or if it will help or worsen me. After 20 + years of varying diagnoses psych docs etc. I (and I am sure many can relate) feel like a lab rat. Yes, I have participated in actual medical studies, but under the care of a psych still feel like a lab rat. With that being said here is my experience with Seroquel and my opinion...
AGITATION- YES!
IRRITABILITY- YES!
Sedation & knocking me out to sleep yes. Even on the smallest or a low dose, I take them (or rather don't) PRN. I wake up feeling crappy as all hell. yes I may have slept which I needed because the psychosis was bad, but nor my body nor mind slept. I was more tired (not including the lingering fogginess) but my body, while was asleep, did not rest to regenerate itself. Any my mind went through hell and back. I wake up in the middle of the night sweating insanely, have not nightmares but night terrors, like trying to wake myself up but can't and if i do have to make myself stay up long enough not to fall back into the night terror. And still then I fall right back into it. I will have my jaw clenched a headache and tears running down my face. Crying in my sleep, for no particular reason just crying and crying. Its not the worst side effect I have suffered from a psych med but it is in my top 3. The next day I am "switching" like mood swings way too rapidly, like 10 minutes tired n just kinda blah, to not wanting to end it all but just like a very concerning level of depression, & irritability not just small cries like oh poor me, but like Emmy award-winning torture cry.
Most medications I would say try to ride out because it takes a while to get in your system and work or not work with your other meds, but it is a very old anti-psychotic like thorazine, think one flew over the coo coos nest. Its kind of a PRN but not exactly. If you have the bad reaction, with these old anti-psychotics as far as my experience and pharmaceutical knowledge the side effects will not even out, maybe lessen but its your mind and body that has to adjust to it it will not adjust to your body and mind.
Hope this helps but doesn't frighten you, if it does I am sorry but I don't want anyone to experience what I had to.

[La.Last.Lucy]

Originally Posted by Guiness187055

No irritability here. Just tons of sedation and one heck of an appetite.

I think he owes us all an apology....
or at least those of us who dare to see
beyond the fog of religiosity

it's tiresome
These intermittent assaults
of reality
I hold onto the idea of our identity
at times feeling cursed
makes us stronger
for we have been through the worst-

to experience

face to face beauty
a creativity that blows
ones mind
laughter until we cry
euphoria like the best high
- WE will be the first

[glennk]

Don't have irritability, but do have pretty bad leg and hand movements. Does anyone know if this will become permanent (like with Haldol)?

[CaminoDeOro]

Thanks everybody for your experiences. It looks like irritability and agitation are more common than I realized with atypical antipsychotics. I wonder how closely related it is to akathisia/restless leg, which I've never noticed with anything but seroquel.

Regarding the Prozac/Zyprexa combo, it's something to consider but Prozac by itself (before my bipolar diagnosis, in fact it's what led to my bipolar diagnosis) was great for me for maybe a year or more, but then tipped me into a stretch of apocalyptic ultrarapid cycling the likes of which I've never seen before or since. It was truly unbelievable. My old pdoc had lost his license and so I wasn't under care for a while and just kept taking it. So if we do end up trying it, it would be very closely monitored. But Zyprexa also has bad physical side effects for me, the weight gain is unbelievable, I naturally have high cholesterol and it pushes it into heart attack territory, and I got gynecomastia on one side on 2.5mg the first time :|

Regarding the older typical antipsychotics, based on recent flowchart type recommendations for bipolar II, in my understanding they would be last-resort treatments with the exception of clozapine. Everything is on the table here but seroquel alone is actually one of the first suggested treatments for bipolar II with resistant depression, followed by seroquel plus a stabilizer like Lamictal or Depakote. I am scared to death of getting TD (the tongue flop / chewing / hand twisting movement disorder) which is a lot more likely with the older antipsychotics. It's always a cost-benefit analysis - I don't end up hospitalized ever and the most intensive outpatient I've done is DBT. Bipolar II is still destroying my life but in a lowkey way that hopefully will need less severe management.

Regarding hand and leg motions, if it is due to a feeling of restlessness that would be akathisia. With Zyprexa, I had tremor and I thought maybe I had some twisty hand movements rarely while walking. I am super paranoid about this and brought it up to pdoc. She said it was very unlikely to be TD but that there was an easy test, namely you increase the dose of the medication for a few days and see if the movement issues stop. It's paradoxical but I looked it up and it's a known thing and the way it works based on understanding of TD in the brain makes sense. Anyway we did this and nothing changed, later we figured out it was my ADHD meds and changed them which solved it.

That being said, ANY movement issues and/or physical restlessness with antipsychotics, talk to your pdoc ASAP and if they blow it off consider getting a second opinion. Once it gets going it can be permanent.

[La.Last.Lucy]

Originally Posted by glennk

Don't have irritability, but do have pretty bad leg and hand movements. Does anyone know if this will become permanent (like with Haldol)?

For me (everyone is different) having been on seroquel and various other older medications since about age 19 (33 now) it definitely gave me Akathesia- Tardive- and muscle spasms uncontrollable ticks. They would always prescribe cogentin or propranolol to combat the side effects... yes more pills.... I have been off medications that cause those side effects for about 4-5 years now. I still have permanent ticks akathesia and tardive(not very often). They are not always present but will flare up... while sleeping sometimes the ticks... also when my anxiety is high or just for no reason my hands tremor very badly. I used to be a decent artist, but now even my handwriting or ability to take a non blurry pic on a cell phone (even with image stabilizer) is a rarity.

[glennk]

Thanks everyone for their awesome (and quick) responses. I'm going through a low point right now. I'm transitioning from a mixed episodes to more depressed. My new Pdoc is trying something new (for him). We've lowered my Seroquel XR to 400mg (from 600) and added Latuda 40mg. The combination appears to be working and raising my mood up. Not sure this is going to turn out, but I'm willing to try anything right now.

Lala Lucy: As for medications, I currently take 6 for my bipolar....and every time someone mentions another drug, I just want to scream. Somedays I feel like a zombie, while others I just scrape by. I *wish* there were one pill without all the side effects, so I could go back to work.

[CaminoDeOro]

Okay this morning I'm noticing something interesting. I woke up with very high physical tension/activation, which is why I started this thread in the first place. Based on my experience the past few weeks, with this level of tension I'm very likely to go hypo today, and really the question is whether it will be dysphoric (irritability/rage) or euphoric (subjectively AWESOME but derails my whole agenda). I suspect that's strongly influenced by how I start my day and how much socializing I do.

Here's the weird and interesting thing though. This morning, and I've noticed this a bit on other days but today it really stands out, the physical tension seems to be disconnected from my level of mental stimulation. My alarm went off and I became conscious and immediately thought "crap, I'm really wound up." But I could have easily gone right back to sleep. I normally take a long time to wake up with multiple alarms etc, and this isn't really changed when I'm waking up with this strange physical activation. It still took me almost an hour to really wake up, hitting snooze etc this morning, like always. But when I'm conscious holy crap am I keyed up. I mean sometimes breathing hard while I'm lying in bed. Feeling like I could do a kool-aid man act and jump through walls.

As you can imagine, it is VERY easy for a state like that to turn into agitated hypomania, and sometimes euphoric.

What on earth is going on. The only thing vaguely similar I've experienced is having too much caffeine, which doesn't really wake me up, so I will be sleepy but physically wired in a somewhat similar way.

Come to think of it, this weird agitation type effect has basically felt like I've been on too much caffeine for weeks on end. I barely have any caffeine in my diet either.

[La.Last.Lucy]

Originally Posted by CaminoDeOro

Okay this morning I'm noticing something interesting. I woke up with very high physical tension/activation, which is why I started this thread in the first place. Based on my experience the past few weeks, with this level of tension I'm very likely to go hypo today, and really the question is whether it will be dysphoric (irritability/rage) or euphoric (subjectively AWESOME but derails my whole agenda). I suspect that's strongly influenced by how I start my day and how much socializing I do.

Here's the weird and interesting thing though. This morning, and I've noticed this a bit on other days but today it really stands out, the physical tension seems to be disconnected from my level of mental stimulation. My alarm went off and I became conscious and immediately thought "crap, I'm really wound up." But I could have easily gone right back to sleep. I normally take a long time to wake up with multiple alarms etc, and this isn't really changed when I'm waking up with this strange physical activation. It still took me almost an hour to really wake up, hitting snooze etc this morning, like always. But when I'm conscious holy crap am I keyed up. I mean sometimes breathing hard while I'm lying in bed. Feeling like I could do a kool-aid man act and jump through walls.

As you can imagine, it is VERY easy for a state like that to turn into agitated hypomania, and sometimes euphoric.

What on earth is going on. The only thing vaguely similar I've experienced is having too much caffeine, which doesn't really wake me up, so I will be sleepy but physically wired in a somewhat similar way.

Come to think of it, this weird agitation type effect has basically felt like I've been on too much caffeine for weeks on end. I barely have any caffeine in my diet either.

Morning/Afternoon-
This may not help the way you are feeling but I have been through this so I genuinely understand and hope knowing that this isn’t just you may give some comfort.
I completely understand the mania (hypomania another diagnosis) it is frightening to be unsure if the manic will turn into irritability irrationality or even worse bs maybe euphoria. I don’t know you but if I could physically be there with u I would- if you’re alone or with someone who doesn’t understand it can make things worse, I get very upset when my significant other does not have answers or comforting words or naturally wants to be more “loving” knowing what we are feeling.
The feeling will pass. I don’t want to tell you wether it will be euphoric or jaw clenching. I do not know how u deal with episode or how you like to be comforted or “coping techniques” fricken hate that word, are.
Feel free to message me anytime even if you don’t want a response just to express what your feeling to get it out, but not like journaling, knowing that another human being is listening.

[HALLIEBETH87]

I was enraged most
Of my time on seroquel

[CaminoDeOro]

Thanks for the well wishes. I am definitely elevated today but I fell only mildly on the irritable side. Managed to get a bunch of random little things done, plus volunteer 3 hours, walk a bit, and eat a balanced meal for the first time in 5 days. If I'm gonna have the energy I'm gonna milk it.

It's just the sensation of being *physically* wired all the time that seems so foreign.

[glennk]

Quick update:
The Latuda is working. I'm now waking up after 6-7 hours and feel ready to roll. Down side is that 2 hours after taking the Latuda, I'm in a restless state with anxiety features. To combat this, I'm taking Gabapentin 400mg and Ativan 1mg prior to the Latuda. Ugh!

[glennk]

Originally Posted by glennk

Quick update:
The Latuda is working. I'm now waking up after 6-7 hours and feel ready to roll. Down side is that 2 hours after taking the Latuda, I'm in a restless state with anxiety features. To combat this, I'm taking Gabapentin 400mg and Ativan 1mg prior to the Latuda. Ugh!

Had to back down to 20 of Latuda. The restlessness started causing me to think i was losing my mind.

[CaminoDeOro]

OP here, I've definitely settled in to a 5-7 day ultrarapid cycle with periods of high instability. Trying to get my pdoc appointment moved up but it's next week anyway. My life is quite disrupted right now, I should have a relatively chill period between November 10 and December 15 or so if no additional random BS happens, so I guess we'll have to see if whatever the pdoc and I change, works, during that period, because after that I'm probably going to be traveling for a few weeks to avoid a toxic situation around the holidays where I live. It's better for my mental health to crash on friends' couches (as I am doing right now, one of the toxic elements also scheduled a visit for Halloween) than stay where I live during that time. But I am REALLY not looking forward to having med flux during that so hopefully we find something that is better at this next appointment. Otherwise maybe I'll go back on zyprexa - AGAIN - for a month or two because at least it keeps me stable, even though it does nothing for the depression. Being around my friends I haven't seen in 5 years will probably keep me from getting too depressed during that month.

[~Christina]

I hope you find a medication that helps and doesn’t have hellish side effects.